CERTIFICATION OF THE APPROVAL OF WATER AND SEWERAGE SYSTEMS

ARTICLE 9 FORMS AND CHECK LISTS 9.100 On preliminary layout & final subdivision plat CERTIFICATION OF THE APPROVAL OF WATER AND SEWERAGE SYSTEMS I hereby certify that the (...type: private or pubic...) water supply and (...type: private or public...) sewage disposal system installed, or proposed to be installed in the subdivision entitled: (...name of subdivision...) fully meets the requirements of the Health Department, and hereby is approved as shown. County Health Officer 9.150 On preliminary layout and final subdivision plat CERTIFICATION OF AVAILABILITY OF WATER SERVICES I hereby certify that the proposed subdivision shown hereon lies within the service area of (...name of water company...) and that said utility has the capacity to supply water to the proposed subdivision, subject to the water distribution system being installed within said subdivision according to the requirements of this Agency and all other requirements that may apply, then water service shall be supplied by this agency. Authorized Representative 9.200 On preliminary layout & final subdivision plat CERTIFICATION OF THE AVAILABILITY OF SEWAGE DISPOSAL SERVICES I hereby certify that (...name of agency or company...) has capacity to Serve (...name of subdivision...) with sewage disposal services subject to the sewer system of said subdivision meeting the requirements of this agency and being installed according to those requirements, then sewer disposal services shall be supplied by this agency. Authorized Representative 75

9.250 On final subdivision plat CERTIFICATE OF OWNERSHIP AND DEDICATION We hereby certify that we are the owners of the property shown hereon and that we hereby adopt this plan with our free consent. This division does not violate any private subdivision restrictions. Owner/Owner s 9.300 On final subdivision plat CERTIFICATE OF ACCURACY I hereby certify that this survey was made by me or under my direct supervision and complies with the standard of practice for surveying in the State of Kentucky as set forth in 201 KAR 18:150. Registered Engineer or Surveyor 76

9.350 On final subdivision plat HEALTH DEPARTMENT CERTIFICATION I hereby certify that this subdivision shown hereon is situated in an area generally suitable for on site sewage disposal with each tract requiring an on site evaluation test to determine the exact location and type of system to be installed. Shelby County Health Officer 9.450 On final subdivision plat ROADWAY ENTRANCE CERTIFICATE I hereby certify that an entrance from the proposed development will be granted onto the city street, county road, or state highway on the plat described hereon. However, an entrance permit for each lot will be required after structure location is established. City Street, County Road, or State Highway Official 9.500 On final subdivision plat FIRE PROTECTION CERTIFICATE I hereby certify that the subdivision show hereon lies within the service area of this Fire Department or Fire District and will be serviced by this agency. Additionally, the subdivision hereon meets or exceeds fire protection requirements for the City of Shelbyville and the County of Shelby. The current ISO fire rating of this subdivision shown hereon is. Fire Department Fire Chief 77

9.501 On final subdivision plat CERTIFICATE OF APPROVAL I hereby certify that this plat of (...name of subdivision...) has been approved by the Triple S Planning Commission. Triple S Planning Commission Chairman 9.502 On final subdivision plat CERTIFICATE OF APPROVAL FOR ELECTRIC SERVICE I hereby certify that this plat of (...name of subdivision...) lies in the service area of (...electric company name...) and said utility has the capacity to supply adequate electric service to said subdivision. Authorized Representative 9.503 On final subdivision plat CERTIFICATE OF APPROVAL FOR GAS SERVICE I hereby certify that this plat of ( name of subdivision...) lies in the service area of (...gas company name...) and said utility has the capacity to supply adequate gas service to said subdivision. Authorized Representative 9.504 CERTIFICATE OF DRAINAGE APPROVAL FOR CITY OF SHELBYVILLE I hereby certify that the development hereon meets all the requirements for drainage in the City of Shelbyville. City of Shelbyville Engineer 78

9.505 CERTIFICATE OF DRAINAGE CONSTRUCTION Upon construction of bonded drainage improvements represented by Planned Unit Developments, Subdivision Plats or Development Plans the Developer or Owner shall be required to provide a letter of certification to the Triple S Planning and Zoning Commission from a Professional Engineer licensed in the Commonwealth of Kentucky that the drainage improvements shown on the plans have been constructed so as to satisfy the intent of the original design. Any significant changes from the original design shall be noted in the certification, and the certifying engineer shall comment as to the effect these changes had on the original design. Engineer/Surveyor 9.506 PRELIMINARY PLAT PREPARATION CERTIFICATE I hereby certify that this preliminary plat was prepared by our engineering/surveying firm. The plat does not represent a survey and is not a record able document. Engineer/Surveyor 9.507 STATE ROADWAY ENTRANCE CERTIFICATE I hereby certify that an entrance from the proposed development may be granted onto the State Route, at the location shown hereon, subject to meeting all criteria of, and obtaining a State encroachment permit for the entrance. There shall be no additional direct vehicular access to the State Route unless shown on the plan. Highway Official 9.508 CERTIFICATE OF EARLY WARNING SYSTEM I hereby certify that this Early Warning System complies with Shelby County Emergency Management Agency requirements. Authorized Representative 79

9.550 CERTIFICATE OF APPROVAL OF UTILITY EASEMENTS BY UTILITY & TELECOMMUNICATIONS COMPANIES I, being a duly authorized agent of the cited utility/telecommunications company, hereby accept the utility/telecommunications easements shown on this plat on behalf of said company. Kentucky Utilities Co. AT&T Shelby Energy Gas Company Water Company Sewer Company Time Warner Cable Owner The spaces indicated by dashed lines and marked utility & telecommunications easements are hereby reserved for the use of the utility/telecommunications companies listed above for utility purposes and water and gas companies for underground pipes, electric utilities, and telecommunications purposes, which include: 1. The right to construct maintain, operate, replace, upgrade, or rebuild pole lines and/or pipes, and/or underground cable systems and all appurtenances thereto, 2. The right of ingress and egress over all lots to and from said easements indicated, 3. The right to trim or remove any trees necessary to maintain proper service, 4. The right to keep said easements free of any structures or obstacles that may create a hazard to the said poles, pipes, cables, or lines, and 5. It is understood that as a part of this reservation the owners, their heirs, or assigns hereby agree that no excavation will be attempted within five (5) feet of any buried pipe and/or cable installed, or change of grade that interferes with overhead pole lines within the easements herein defined. Property owners are to use and enjoy the said lands included in the easement strips shown hereon but such use shall not interfere with the rights and privileges herein granted. 80

CERTIFICATES FOR DEVELOPMENT PLAN Only for subdivision's approved after March, 1994. 9.600 FIRE PROTECTION CERTIFICATE I hereby certify that the Development Plan hereon meets requirements of this agency and is approved. Fire Agency Official 9.601 CERTIFICATE OF APPROVAL I hereby certify that this Development Plan has been approved by the Triple S Planning Commission based on compliance with the required certifications. Commission Chairman Triple S Planning Commission 9.602 CERTIFICATE FOR DRAINAGE DESIGN APPROVAL I hereby certify that the proposed drainage design, as shown on this Development Plan, is adequate for proper drainage without causing any adverse affects to the adjoining properties. Engineer 9.603 CERTIFICATE OF OWNERSHIP I (we) hereby certify that I (we) are the owners of the property shown hereon and that I (we) adopt this development plan with our free consent and assure compliance with the LIGHT, NOISE AND ODOR Ordinance of Shelby County. Owner/Owner s 81

9.604 ROADWAY ENTRANCE CERTIFICATE OF APPROVAL I hereby certify that the entrance shown on this development plan has been granted by this agency; however an entrance permit will be required before a zoning permit can be issued. City Engineer, County Road Engineer or State Highway Official (Please Circle Appropriate Agency) 9.605 LIGHT, NOISE, AND ODOR CERTIFICATE I hereby certify that this development complies in with (will comply with) the Light, Noise and Odor ordinance of Shelby County. Engineer 9.606 HYDRAULIC STUDY/ANALYSIS CERTIFICATE I hereby certify that appropriate measures have been identified and taken to satisfy the requirement that no off-site or on-site property owner will suffer any water related damage as a result of this development and this design is in accordance with the required study. Engineer 82

THE FOLLOWING CHECKLISTS ARE FOR THE PURPOSE OF LISTING INFORMATION ON THE APPLICABLE PLAT AND MUST BE ON SAID PLAT BEFORE CONSIDERATION BY THE TRIPLE S PLANNING COMMISSION 83

SUBDIVISION PRELIMINARY PLAT CHECK LIST (to be filed with Planning Commission) Name of Subdivision Location Owner(s) Address Developer Address Fee Paid Present Zoning of property being subdivided shown Certificate of Approval by County Health Officer Certificate of Approval by Water Service Certificate of Approval by Sewer Service Certificate of Utility Easements Certificate of Fire Protection Certificate of Approval of Street Plans Certificate of Approval for Entrance to Highway Thirteen Copies Submitted Drawing Size of 24 x 36 Maximum Scale of 1 = 100' or less, as applicable Name and Location of Subdivision on Plat Vicinity Map Name and Address of Developer Name and Address of Owner Name and Seal of Engineer or Surveyor on Plat Acreage of Tract being Subdivided and Graphic Scale North Arrow Adjacent Property Owners and addresses identified, as well as on separate sheet Contour Lines at 5 Feet Intervals or Less Boundary Lines of the tract being subdivided Existing or Proposed Streets on or adjacent to the proposed Subdivision with dimensions and grades Existing or Proposed Easements on or adjacent to the proposed subdivision with dimensions Existing and Proposed utilities on or adjacent to the proposed subdivision with proposed connections shown Lot Lines and Lot Numbers Sites for Public Dedication Other Than Streets Setback Lines Protective Covenants submitted *(See page 85) Larger Tract Shown if portion only being subdivided Location of pertinent natural features 84

Location of existing drainage structures Location of right of ways for streets/roads Traffic Impact Study attached to this submittal Erosion Control and Sediment Plan review comments attached to this submittal Lighting Plan Hydraulic/Study Analysis Check list prepared by: : 85

FINAL SUBDIVISION PLAT CHECK LIST (to be filed with Planning Commission) Name of Subdivision Location Developer Address Owner(s) Address Construction of Improvements Security Bond Posted Fee Paid Certificate of Ownership and Dedication Certificate of Accuracy, name and seal of Surveyor Certificate of Approval of County Health Department Certificate of Approval of Water System and specs Certificate of Approval of Sewerage System and specs Certificate of Approval for Recording Certificate of utility easement by utility companies Certificate of Fire Protection Certificate of Early Warning System Thirteen Copies Submitted Drawing Size of 18 x 24 maximum Scale of 1 = 100' or Less as applicable Name of Subdivision on Plat Name and Address of Owner(s) on Plat Acreage of Tract for Subdivision Adjacent property owners and addresses identified, as well as on separate sheet, graphic scale and north arrow Boundary Lines with bearings and distances Vicinity Map Existing and proposed Easements shown and dimensioned Existing and proposed Streets shown and dimensioned Lot Lines with Bearings and Dimensions Building Lines Shown All curves defined with adequate information Streets named Lot Numbers and area shown Sites for public dedication, other than street shown Protective Covenants submitted *(See page 85) Identification of Monuments shown on plat Street Plans submitted with grades, profiles, drainage Street Right-of-Ways shown and dimensioned Street cross sections submitted Existing utilities identified as to size and type Location of pertinent natural features Lighting Plan 86

Hydraulic Study/Analysis Floodplain Note Checklist prepared by: : 87

ZONING CHANGE PLAT CHECKLIST (to be filed with Planning Commission) Owner: Address: Current Zoning: Proposed Zoning: Proposed Used: Fee paid Present and proposed zoning of the property Name and seal of Surveyor preparing the plat Name and address of adjacent property owners, as well as on separate sheet Name and address of property owner Certificate of Ownership Present zoning of all adjacent property Certificate of Approval to be signed by Chairman Acreage of Tract or Tracts Any division of the property, existing or planned Intended use of the property indicated on the plat Existing buildings, driveways and parking Proposed buildings, driveways and parking Distance to the nearest street or road intersection Vicinity Map Copy of the deed attached and Graphic scale North Arrow Boundary lines with bearings and distances Existing and/or proposed set back lines Existing Streets Thirteen Copies submitted Scale 1 = 100 or less as applicable Drawing size 24 x 36 maximum, smaller as applicable Buffer Zones Shown Existing utilities show and identified Traffic Impact Study attached with this submittal Lighting Plan Checklist prepared by: : 88

MINOR SUBDIVISION or ACREAGE TRACT CHECKLIST (To be filed with Planning Commission) Name of Owner Address Name of Subdivision Fee Paid Name and address of owner and developer Thirteen Copies Certificate of County Health Department Certificate of Water Service Certificate of Utility Easements Certificate of Entrance Certificate of Fire Protection Certificate of Ownership and Dedication Certificate of Availability of Sewer Service Certificate of Approval for Recording Certificate of Early Warning System Present Zoning Name of Subdivision Name, seal and certificate of accuracy by Surveyor Drawing size 18 x 24 maximum Scale 1 = 100' or less as applicable Vicinity Map, Graphic Scale, and North Arrow Acreage of tract being subdivided Remaining acreage of parent tract shown Adjacent property owners and addresses identified, as well as on separate sheet Lot lines with bearing and dimensions Lots numbered and areas shown Existing and proposed right-of-way shown and dimensioned All curves defined with adequate information Building lines shown Location of existing utilities shown, size and type Location of pertinent natural features shown Existing drainage shown Identification of Monuments shown on plat Protective Covenants Submitted *(See page 85) Agricultural Note Checklist prepared by 89

PUD and DEVELOPMENT PLAN PRELIMINARY CHECKLIST (To be filed with Planning Commission) Owner Address Developer Address Fee paid Present Zoning of property being developed Name of Development Name and Address of Owner Name and Address of Developer Present Zoning of adjoining property Name and seal of surveyor and/or engineer Certificate of Fire Protection Certificate of approval of Street or Road plans Certificate of approval for Entrance to Highway Certificate of approval by County Health Department Certificate of availability of Sewer Service Certificate of availability of Water Service Certificate of availability of Electric Service Certificate of Utilities Easement Certificate of street approval Thirteen copies submitted Drawing size 24 x 36 maximum Scale 1 = 100' or less as applicable Acreage of tract being developed Vicinity Map and Graphic Scale North Arrow Adjoining property owners and address identified, as well as on separate sheet Existing contour lines at 5 foot intervals or less Boundary line of the tract being developed Existing and proposed streets on or adjacent to the proposed development with dimensions and grades Existing and proposed easements on or adjacent to the proposed development with dimensions Existing and proposed utilities on or adjacent to the proposed development with proposed connections shown Lot lines shown Lots numbered Sites for public dedication other than street shown Set back lines Open spaces shown 90

Larger tract shown if portion only being Developed Location of pertinent natural features Location of existing drainage structures Phasing or Stages of Development Overall density calculations Parking Requirements Loading and or Unloading areas shown Access points shown Buffer Zones shown Street and Parking Lighting Existing topography Floor Areas Ratio of floor space to land area Buildable area shown Yard lines Distance between buildings Height of structures Proposed Signage Traffic Impact Study attached to this submittal Erosion Control and Sediment Plan attached to this submittal Lighting Plan Hydraulic Study/Analysis Protective Covenants Submitted *(See page 85) Checklist Prepared by: 91

PUD and DEVELOPMENT PLAN FINAL PLAT CHECKLIST (To be filed with Planning Commission) Name of Owner Address Name of Development Name of Developer Fee Paid Bond Posted Name of Development Name and address of adjoining property owners identified on plat as well as on separate sheet Present zoning of adjoining property Name and address of owner and developer Name, seal and certificate of accuracy by Surveyor Certificate of Fire Protection Certificate of approval for Entrance to Highway Certificate of approval for County Health Dept. Certificate of approval of Water plans and specs. Certificate of approval of Sewer plans and specs. Certificate of approval of Street plans Certificate of Ownership and Dedication, if required Certificate of Approval Certificate of Early Warning System Approval of Utility Easements by utility companies Thirteen copies submitted Drawing size 24 x 36 maximum DP, 18 x24 PUD Scale 1 = 100' maximum Vicinity map, graphic scale and north arrow Acreage of tract being developed shown Boundary lines of tract with bearings and distances Existing and proposed street shown and dimensioned Existing and proposed easements shown and dimensioned Lot lines with bearings and easements All curves defined with adequate information Lots numbered and area shown Sites for public dedication, other than street shown Building lines shown Protective covenants submitted *(See page 85) Streets named Identification of monuments shown on the plat Street plans submitted with grades, profiles and drainage Street cross sections submitted Existing utilities identified as to size and type 92

Street right-of-ways shown and dimensioned Location of pertinent natural features Phasing or stages of development Overall density calculations Parking Areas on and off street Loading and unloading areas Access points Buffer Zones shown Lighting for street and parking Existing topography Floor areas Ratio of floor space to land areas Buildable area shown Yard lines Distance between buildings Height of structure Proposed signage Lighting Plan Erosion Control Plan Hydraulic Study/Analysis Checklist prepared by: 93

COMMERCIAL/INDUSTRIAL DEVELOPMENT PLAN CHECKLIST (To be filed with Planning Commission) Only for subdivision's approved after March, 1994 Name of Owner Address Name of Record Plat, Plat cabinet and slide number Fee Paid Subdivision name and lot number Name and address of owner Name and seal of surveyor Certificate signed by engineer for lighting, noise and odor Certificate of approval for Fire Protection Certificate for Drainage Design and engineer's stamp Certificate of Ownership Certificate of Roadway Entrance Certificate of Early Warning System Thirteen copies submitted Drawing size 24 x 36 maximum Scale 1 = 100' maximum Vicinity map, graphic scale and north arrow Acreage of tract being developed Boundary lines of tract with bearings and distances Existing and proposed street shown and dimensioned Existing and proposed easements shown and dimensioned All curves defined with adequate information Building lines shown Identification of monuments shown on the plan Existing utilities identified as to size and type Street right-of-ways shown and dimensioned Location of pertinent natural features Parking areas identified Loading and unloading areas Access points Buffer areas shown Lighting, noise and/or odor identified on plan Existing topography Floor areas Ratio of floor space to land areas Yard lines Distance between buildings Height of structure Proposed signage Drainage plan with engineer's stamp 94

Erosion Control and Sediment Plan attached to this submittal Lighting Plan Hydraulic Study/Analysis Landscape Plan Checklist prepared by: 95

*PROTECTIVE COVENANT GUIDELINES The following are minimum requirements that should be submitted with the application. 1. Minimum square footage of dwellings. 2. Any prohibited activities or uses. 3. Permitted accessory structures, if any. 4. Stipulation that restrictions run with the land. 5. Restrictions on usage of any tracts, if any. 6. Specific duties of landowners, if any. 7. Architectural restrictions, if any. 8. Statement of enforcement provisions. 96